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Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent.

Methods

Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS).

Results

In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9–9.4; p = 0.05).

Conclusions

Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.

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Acknowledgment

The authors declare no financial support and no funds received.

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Authors and Affiliations

  1. Department of Radiation Oncology, Institut Gustave-Roussy, Université Paris Sud, Villejuif, France

    Antonin Levy MD, Cécile Le Péchoux MD & Ryan Bouaita MD

  2. Department of Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Institut Gustave-Roussy, Villejuif, France

    Antonin Levy MD, Cécile Le Péchoux MD, Philippe Terrier MD, Ryan Bouaita MD, Julien Domont MD, Olivier Mir MD, Sarah Coppola MD, Charles Honoré MD, Axel Le Cesne MD & Sylvie Bonvalot MD, PhD

  3. Department of Pathology, Institut Gustave-Roussy, Villejuif, France

    Philippe Terrier MD

  4. Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France

    Julien Domont MD, Olivier Mir MD & Axel Le Cesne MD

  5. Department of Surgery, Institut Gustave-Roussy, Villejuif, France

    Sarah Coppola MD, Charles Honoré MD & Sylvie Bonvalot MD, PhD

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  1. Antonin Levy MD
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  2. Cécile Le Péchoux MD
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Correspondence to Sylvie Bonvalot MD, PhD.

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Levy, A., Le Péchoux, C., Terrier, P. et al. Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment. Ann Surg Oncol 21, 269–276 (2014). https://doi.org/10.1245/s10434-013-3247-4

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  • DOI: https://doi.org/10.1245/s10434-013-3247-4

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